“Volatile organic compounds of plants and sheep milk at two

Hereditary Cancer in Clinical Practice 2005; 3(4) pp. 179-180
Hereditary Breast-Ovarian Cancer Team
of the University Medical Centre Groningen (UMCG) – a Report
Marian J.E. Mourits1, Jan C. Oosterwijk2, Jakob de Vries3
1Dept. of Gynaecologic Oncology; 2Dept. of Medical Genetics; 3Dept. of Surgical Oncology, University Medical Centre Groningen (UMCG), University of Groningen,
The Netherlands
Corresponding author: Marian J.E. Mourits, MD PhD, Dept. of Gynaecologic Oncology, University Medical Centre Groningen
(UMCG), University of Groningen, Hanzeplein 1, 9700 RB, The Netherlands
Submitted: 1 November 2005
Accepted: 10 November 2005
Female carriers of a germline BRCA1 or BRCA2
mutation have a cumulative lifetime ovarian cancer risk
of 39-54% or 11-23%, respectively [1, 2]. Preventive
health strategies for these women include gynaecological
screening aiming at early cancer detection and
prophylactic salpingo-ophorectomy aiming at cancer risk
reduction. However, it is becoming increasingly clear that
(bi) annual gynaecological screening by transvaginal
ultrasonography and serum CA125 estimation in women
at increased risk of ovarian cancer is ineffective in
detecting presymptomatic ovarian cancer [4]. In a recent
publication a positive predictive value of 17% and
a sensitivity of less than 50% were found for screening
for ovarian cancer in a high-risk population [3]. Preventive
bilateral salpingo-oophorectomy (BSO) reduces ovarian
cancer risk by 96% and breast cancer risk by 50% or less,
depending on the age of preventive surgery. Preventive
BSO at a premenopausal age is the most effective
strategy to prolong life in the case of a BRCA1 mutation
[5]. In our clinic, we therefore counsel women with
a BRCA1/2 gene mutation to choose preventive surgery
after childbearing age. From the age of 35-40 for BRCA1
mutation carriers and from the age of 40-45 for BRCA2
mutation carriers, these women are advised to undergo
a laparoscopic BSO. Counselling is provided at our
multidisciplinary outpatient clinic by an experienced
gynaecologist who discusses the benefits and drawbacks
of the decision for or against preventive surgery with the
patient and the (contra) indications for hormonal
replacement therapy (HRT). Additional psychological
counselling is available from the team’s psychologist. In
our clinic, uptake of preventive BSO is more than 70%
Hereditary Cancer in Clinical Practice 2005; 3(4)
in the total group of counselled mutation carriers and
rises to more than 90% in women by the time they reach
the age of 50 years.
The operation is performed in a day care setting
and starts with peritoneal washing for a cytologic
examination to detect subclinical (extra) ovarian or
tubal cancer, followed by BSO. Atraumatic tissue
handling is performed by grasping the ovarian pedicles
instead of the ovarian epithelium. The fallopian tube
is removed from the uterine corner by bipolar
coagulation and only the intramural part of the tube is
left in situ. After marking one adnex, the adnexa are
taken out of the body by an endobag. The tissue is sent
for histopathological examination.
Since the publications of case reports linking BRCA
mutations to an increased risk of fallopian tube cancer
as well, preventive oophorectomy is recommended to
be replaced by BSO [6]. Although the rationale for
removing the total fallopian tube by removing the
uterus as well is clear, we could not find any evidence
that a hysterectomy adds to reducing the risk of
fallopian tube cancer more than a complete BSO
alone. In a large clinicopathologic study of 105 cases
of fallopian tube cancer, 92% were situated in the tubal
portion, most often the distal part, while 8% were
confined to the fimbriae [7].
Following preventive BSO, women who are younger
than 45 years of age and have no history of breast cancer
are counselled to use HRT, to treat vasomotor symptoms
179
Marian J.E. Mourits et al
and sexual side effects of oestrogen deprivation. In the
case of prescription of HRT, we prescribe tibolone,
because in contrast to oestrogen/progestogen treatment,
it appears to exert little stimulation of breast tissue and
does not increase the mammographic breast density [8].
Women who have been treated for breast cancer,
or are older than 45-50 years of age, are advised not
to use HRT. In the case of severe vasomotor symptoms,
non-hormonal treatment is proposed by selective
serotonin reuptake inhibitors (SSRI).
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